Background

Although numerous reports have described interventions designed to influence antibiotic utilization, to our knowledge none have been evaluated in a randomized study.

Methods

Adult inpatients receiving 1 or more of 10 designated parenteral antibiotics for 3 or more days during a 3-month period were randomized to an intervention (n=141) and a control (n=111) group using an unblocked, computer-generated random number table.

Obstetric patients and those seen in infectious disease consultation were excluded.

The intervention group received antibiotic-related suggestions from a team consisting of an infectious disease fellow and a clinical pharmacist.

Both groups were evaluated for clinical and microbiological outcomes as well as antibiotic utilization via prospective chart reviews and analysis of the hospital's administrative database.

Results

Sixty-two (49%) of the intervention group patients received a total of 74 suggestions.

Sixty-three (84%) of these suggestions were implemented ; the majority involved changes in antibiotic choice, dosing regimen, or route of administration.

Per patient antibiotic charges were nearly $400 less in the intervention group vs controls (P=05).

Almost all the savings were related to lower intravenous antibiotic charges.

Clinical and microbiological response, antibiotic-associated toxic effects, in-hospital mortality, and readmission rates were similar for both groups. (...)